Outcomes and Surgical Strategies of Minimally Invasive Chevron/Akin Procedures

Abstract

Background: Minimally invasive surgery (MIS) is increasingly being used for bunion correction, but limited patient outcome data have been reported for third-generation minimally invasive chevron/Akin (MICA) techniques. The aim of this study was to report on radiographic outcomes, pain control, satisfaction, learning curve, and complication rates in a consecutive series of 94 patients undergoing MICA procedures for hallux valgus. It also describes strategies for avoiding perioperative complications that may arise with MIS bunionectomies. Methods: The treating surgeon’s first 94 MICA procedures were included in the study. Radiographs were reviewed to measure pre- and postoperative intermetatarsal angles (IMAs), hallux valgus angles (HVAs), and soft tissue/bony foot width. Outcome measures, including visual analog scale (VAS) scores and Coughlin satisfaction scores, were obtained. Complication rates were retrospectively assessed though chart review. Statistical analysis was performed using Student t test for continuous variables and χ2 test for categorical variables. Average patient follow-up was 11.2 months. Results: VAS scores dropped 1 week postoperatively, from 5.2 preoperatively to 2.4 ( P < .001). IMA improved from 12.6 degrees to 5.7 degrees at final follow-up ( P < .001), while HVA improved from 26.8 degrees to 10.3 degrees ( P < .001). Bony foot width improved from 92.4 mm to 87.2 mm ( P < .001), and soft tissue foot width improved from 104.1 mm to 100.1 mm ( P < .001). The reoperation rate was 5%, including 3 hardware removals, 1 irrigation and debridement, and 1 neurolysis. Ninety-four percent of patients reported good or excellent satisfaction with the procedure. Complication rates and patient satisfaction scores were similar between the first and second half of patients ( P > .05), suggesting the learning curve was not a factor. Conclusion: In our experience, the MICA osteotomy was a safe and reproducible technique, associated with rapid improvement in pain scores, early weightbearing, significant deformity correction, high patient satisfaction, and low frequency of complications. In addition, the learning curve for the procedure was not as steep as previously reported. Level of Evidence: Level III, retrospective comparative series.